The Observer view on the coronavirus errors that have cost precious lives | Observer editorial | Opinion

Last week, Dr Peter Tun died from coronavirus at the Royal Berkshire hospital in Reading, where he had worked for more than 20 years. His son has reported that he had complained about personal protective equipment (PPE) being reallocated from the ward on which he worked and that at least four patients on that ward later tested positive for Covid-19. “The thought that if only he had a proper protective mask, he might still have been able to enjoy his hard-earned retirement after a lifetime of service just kills me,” his son said on Thursday.

It should haunt us all. Tun is one of at least 55 people working in the NHS who have lost their lives to Covid-19; the true number is likely to be higher, and the number that includes care home and homecare staff even greater still. Every day, medical staff report having to work without adequate protective equipment that would minimise the risk to other patients and to themselves and their families. And on Friday night, it became apparent that Public Health England guidance that stipulates the protective equipment doctors and nurses need to wear when treating patients with Covid-19 has been watered down in the face of national shortages. Staff are now being told to wear flimsy plastic aprons in place of full-length waterproof gowns when the latter run out, a situation many NHS trusts are expected to face this weekend.

There are global shortages of PPE, most of which is sourced from countries such as China, where production has dramatically slowed as a result of the lockdown there. This means that ensuring an adequate supply would always have required finding ways to kickstart domestic production as well as coordinating with other countries to try to expand global production, rather than simply competing for scarce supplies on the open market. There is little evidence that this has been happening behind the scenes and there are few signs that lessons have been learned from other serious errors that the government has made in responding to this pandemic, from its hapless efforts to get extra ventilators manufactured to its slow-off-the-mark attempts to expand testing capacity.

Missed opportunities

Coronavirus is without doubt the biggest logistical challenge our government has faced in decades. No government would get everything right; making some mistakes in a highly pressured and uncertain environment is perhaps inevitable. But there is growing evidence that the British government has made unforced errors that have cost lives. And that, perhaps most critically, there is not much to suggest that ministers are learning from these mistakes in real time, in order to save lives in the future.

There is much to comment on in terms of the lack of preparedness for a pandemic that was predicted by experts and rated as a high risk by the government. In particular, 10 years of underfunding have left the NHS and care services struggling to meet normal levels of demand, let alone with any excess capacity to help them cope with an extraordinary outbreak. We are today paying the price for this disregard of very real threats to our national wellbeing and the cutting back of core public services to the bone.

We cannot turn the clock back now, but it is absolutely right to ask whether the government is learning from the mistakes it has made so far. There have been some real successes. The herculean expansion in critical care capacity that has taken place with the new NHS Nightingale hospitals has been extraordinary. The stay-at-home messaging has encouraged people to respect social distancing and has played a part in bringing down infection rates to the extent that much of that capacity has not yet had to be used.

But there have also been serious, and avoidable, errors. Hindsight makes the decision to ignore World Health Organization advice to test and trace all coronavirus cases, and to delay the imposition of social distancing in the absence of testing and tracing, look even more ill judged than it did at the time. The call-out to the private sector for the production of extra ventilators was only made in mid-March. It has emerged that the government prioritised the production of ventilators built to new specifications rather than existing models and that these specifications were simply inadequate for the treatment of Covid-19 patients. In the meantime, existing British companies that supply and produce ventilators reported that they got in touch with government to offer their support, only to be ignored, while the government missed opportunities to take part in an EU procurement scheme. The Financial Times has reported that, of the two consortiums selected to produce ventilators according to new specifications, one has ended the project and the other has paused it.

There have also been delays around building up testing capacity. And domestic textiles companies report that they have contacted government offering to produce personal protective equipment, but that, as with ventilators, no one has been in touch. It should have been clear from the start that insufficient global supplies would have always meant that the government would have to find a way of working with the private sector here to produce this lifesaving equipment and it is far less complex a product than ventilators. Why the delay? Why did ministers and officials not learn from their mistakes rather than repeatedly asserting there were no problems with supply in recent weeks?

Testing, testing, testing

These questions cannot be reserved for a post-hoc inquiry. Answering them in real time can help save lives today. In a month, will we hear from another son or daughter sharing their anguish that they will live forever with the knowledge that a parent’s life might have been saved if only they had the right protective equipment?

Moreover, improving the effectiveness of the government’s response is key to the ability to safely relax some – though not all – aspects of social distancing. Mass production of a vaccine or of effective treatments that can reduce the mortality rate of the virus are, at the very least, months away. The experiences of places such as South Korea and Hong Kong, which have been able to take a more relaxed approach to social distancing while keeping infection rates lower, suggest that there are ways to ease the burden before then, without putting lives at risk.

If that is possible, it is imperative to do so; the longer it goes on, the worse an impact this lockdown will have on people’s physical, mental and economic wellbeing. But it will be entirely dependent on a huge expansion in the capacity to test and trace contacts in order to prevent any relaxation of social distancing creating another rise in infection and, ultimately, death rates.

The government has pledged to increase testing capacity to 100,000 a day in less than two weeks’ time. But its track record to date does not inspire confidence – it has missed previous targets and is testing at fewer than 20,000 a day currently. It has not been clear about its assumptions about what level of testing capacity would be sufficient to relax social distancing measures in the coming weeks.

On contact tracing, the experience of countries that have done this successfully, such as Singapore, suggest that apps are insufficient alone; they can only be used to support teams of contact tracers and effective plans to get people who are at risk of exposure to observe a strict quarantine, including from others in their household. Yet it would appear that the government has placed far too much emphasis on technology-based solutions, which are already unravelling, and not enough on building up teams of contact tracers, for example, from the thousands of environmental health officers who already work for local authorities.

The government is evading scrutiny for the plans and processes it must get in place now to enable a relaxation of social distancing later on, by claiming it would be inappropriate to talk publicly about an exit strategy in case it undermines the stay-at-home message. This comes across as obfuscation, particularly given the fact that ministers and advisers have seen fit to brief anonymously to the press that the public has been too obedient, and speculation about a relaxation of social distancing being imminent, which is far more undermining of the public health message.

Jeopardising the most vulnerable

Another serious problem with the way the government is handling this crisis is with respect to inequality. Care homes and homecare services have become the forgotten frontline; despite the fact that care workers are looking after those whose lives are most at risk from this virus, they are working with far less protection and guidance than the NHS. The situation makes a mockery of the concept of shielding the most vulnerable from the virus. In prisons, where people have long been locked up in conditions that are a risk to their basic safety, coronavirus is needlessly jeopardising lives, while a plan to release some prisoners early to try to improve conditions has been suspended after basic administrative errors. The same is true in the economy: some of the most precarious and at-risk workers have fallen through the cracks of the government’s schemes, dying in terrible conditions because they are scared of eviction.

Last week, the campaign group Led by Donkeys projected on to the Palace of Westminster footage of NHS workers imploring the prime minister to address the shortages in personal protective equipment. “The NHS saved your life, now we need you to save ours” was the heartfelt plea. No one doubts that ministers want to prevent doctors and nurses needlessly dying on their watch. But, set against a deadly virus that is claiming the lives of our loved ones, good intentions are just not enough.

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